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Abstract Background Veterans are at elevated risk for suicide compared to non-Veteran U.S. adults. Data sources and analyses to inform prevention efforts, especially for those who do not use Department of Veterans Affairs (VA) healthcare services, are needed. This study aimed to link VA and CDC’s National Violent Death Reporting System (NVDRS) data to create a novel data source to characterize the circumstances precipitating and preceding suicide among Veterans, including among those who did not use VA healthcare. Methods Multi-variable, multi-stage, deterministic linkage of VA-Department of Defense (DoD) Mortality Data Repository (MDR) and NVDRS-Restricted Access Database suicide and undetermined intent mortality records within 189 state-year strata (42 states, 2012–2018). Three linkage stages: (1) exact (matched on: age, sex, death date, underlying cause of death, day of month of birth, first initial of last name); (2) probable (all but one variable matched); (3) possible (all but 2 variables matched). Linkage success and accuracy of NVDRS-documented military history were assessed. Results Across all state-years, 22,019 matches (89.20% of 24,685 MDR Veteran records) were identified (65.47% exact). When high missingness (2 + matching variables in > 10% of records; n = 23) or incomplete reporting (n = 12) state-years were excluded, match rate increased to 94.29% (77.15% exact). NVDRS-documented military history (ever served) was accurate for 87.79% of matched records, with an overall sensitivity of 84.62%. Sensitivity was lower for female (61.01%) and younger (17–39 years; 77.51%) Veterans. Conclusions Accurate linkage of VA-DoD and NVDRS data is feasible and offers potential to improve understanding of circumstances surrounding suicide among Veterans.

Abstract Background In the USA, deaths due to suicide, alcohol, or drug-related causes (e.g., alcohol-related liver disease, overdose) have doubled since 2002. Veterans appear disproportionately impacted by growing trends. Limited research has been conducted regarding the relationship between community-level factors (e.g., rurality, community distress resulting from economic conditions) and the presence of spatial clustering of suicide, alcohol-related, or drug-related deaths. We explored community-level relationships in Colorado Veterans and compared suicide, alcohol-, and drug-related death rates between the Colorado adult population and Veterans. Methods 2009–2020 suicide, alcohol-related, and/or drug-related deaths were identified using qualifying multiple cause-of-death International Classification of Disease (ICD)-10 codes in CDC WONDER for the general adult population and Colorado death data for Veteran populations. Age and race adjusted rates were calculated to compare risk overall and by mortality type (i.e., suicide, alcohol-related, drug-related). In Veteran decedents, age-adjusted rates were stratified by rurality and community distress, measured by the Distressed Communities Index. Standardized mortality ratios were calculated to measure spatial autocorrelation and identify clusters using global and local Moran’s I, respectively. Results 6.4% of Colorado Veteran deaths (n = 6948) were identified as being related to suicide, alcohol, or drugs. Compared to rates in the general population of Colorado adults, Veterans had 1.8 times higher rates of such deaths overall (2.1 times higher for suicide, 1.8 times higher for alcohol-related, 1.3 times higher for drug-related). Among Veterans, community distress was associated with an increased risk of alcohol-related [age-adjusted rate per 100,000 (95% CI) = 129.6 (89.9–193.1)] and drug-related deaths [95.0 (48.6–172.0)]. This same significant association was not identified among those that died by suicide. Rurality was not associated with risk for any of the deaths of interest. There was significant spatial clustering for alcohol-related deaths in southeast Colorado. Conclusions Colorado Veterans have higher rates of deaths due to suicide, alcohol-related, and drug-related causes compared to members of the general adult population. Upstream prevention efforts, such as community-based interventions targeting alcohol-use and community economic distress, are warranted. More research is also needed to understand how community distress and other social determinants of health impact the community burden of suicide, alcohol-related, and drug-related mortality.

BackgroundSleep problems are common among Veterans with mild traumatic brain injury (mTBI) and may contribute to participation restrictions. However, explanatory mechanisms underlying this relationship are poorly understood. Sleep problems are associated with post-concussive symptoms (e.g., headaches). In turn, post-concussive symptoms contribute to participation restrictions. We hypothesized that post-concussive symptom severity mediates the purported relationship between sleep problems and participation restrictions among Veterans with mTBI.Materials and MethodsThis study was a retrospective analysis of clinical data among 8,733 Veterans with mTBI receiving Veterans Health Administration outpatient care. Sleep problems (yes/no) were identified using the sleep-related item from the Neurobehavioral Symptom Inventory (NSI). Post-concussive symptoms were measured using remaining NSI items. Participation restrictions were measured using the Mayo-Portland Adaptability Inventory Participation Index. We specified a latent variable path model to estimate relationships between: (1) sleep problems and three latent indicators of post-concussive symptoms [vestibular-sensory (e.g., headache)]; mood-behavioral [e.g., anxiety]; cognitive [e.g., forgetfulness]); and, (2) the three latent indicators of post-concussive symptoms and two latent indicators of participation restrictions (social and community participation [e.g., leisure activities]; productivity [e.g., financial management]). We examined the indirect effects of sleep problems upon participation restrictions, as mediated by post-concussive symptoms. Estimates were adjusted for sociodemographic factors (e.g., age), injury characteristics (e.g., blast), and co-morbid conditions (e.g., depression).Results87% of Veterans reported sleep problems. Sleep problems were associated with greater social and community participation restrictions, as mediated by mood-behavioral (β = 0.41, p

AimsFirearm purchasing increased within the U.S. during the coronavirus disease 2019 pandemic. While rates of firearm ownership and suicide are elevated among women Veterans compared to women non-Veterans, no studies have examined if and how firearm beliefs and behaviors changed among women Veterans during the pandemic. We examined women Veterans' changes in firearm beliefs and engagement in firearm behaviors during the early pandemic era.Method3,000 post-9/11 era women Veterans were invited to participate in a survey. 501 respondents (May-December 2020) comprised the sample for this concurrent nested mixed-method analysis. Thematic analysis and log-binomial regression were used.Results13.88% (n = 69) of women Veterans in our sample reported changes in their firearm beliefs; 22.15% (n = 109) reported engaging in firearm behaviors. The most prevalent reported behaviors were making household firearms more accessible (16.13%) and purchasing ammunition (11.97%). Smaller percentages reported carrying a firearm more frequently (6.71%), loading previously unloaded firearms (5.69%), or purchasing a firearm (4.24%). Thematic analysis suggested firearm behaviors were likely driven by a perceived increased need to protect oneself, family, and property due to: (1) uncertainties brought on by the pandemic; (2) pandemic-related threats necessitating self-defense, preparedness, and self-sufficiency; (3) political, social, and racial unrest and protests. PTSD symptom severity and military sexual assault history were associated with higher prevalence of changes in firearm beliefs and engagement in firearm behaviors during the pandemic.DiscussionConsideration of women Veterans' prior experiences and pandemic-related factors may be necessary to contextualize firearm discussions and inform future research. Given associations of military sexual assault and PTSD symptoms with firearm beliefs and behaviors, it may be crucial to ensure that such discussion are trauma-informed.